Pressing needs: Medicaid funding, primary care, healthier kids

The state’s Medicaid funding crisis is at the top of the list of concerns among members of the Mississippi State Medical Association (MSMA) who met in Biloxi recently for its 140th annual session.

“It is imperative that we fully fund Medicaid — that’s a huge problem in Mississippi,” said president-elect Dr. Randy Easterling of Vicksburg. “MSMA is firmly behind the tobacco tax for this funding and committed to it. I think the governor has staved it off as long as he can.”

Former president Dr. Ed Hill of Tupelo agrees and calls the present method of Medicaid funding “subsidized stupidity.”

“We’ve got to somehow find a way to fund it ongoing and not year-to-year,” he said. “The tobacco tax is one way to have a sustaining revenue stream and discourage smoking. It’s the obvious solution to help with this crisis.”

Noting that MSMA is strongly behind the tobacco tax, Hill also likes the Mississippi Hospital Association’s idea of a user tax on tobacco. “Our policy makers need to look at this and evaluate it,” he said.

Easterling and Hill also reference the need for more primary care providers as a pressing issue in Mississippi.
“We are trying to train more primary care physicians with the rural scholarship program, and 10 new students are starting,” Easterling said. “The average debt for a graduating medical students is $100,000 to $150,000.”

Hill agrees that the rural scholarship program is off to an excellent start, and thinks the re-imbursement system for physicians who practice in underserved areas should be changed.

“We can get someone to practice anywhere if we pay them fairly,” he said. “No one’s been willing to tackle the re-imbursement issue at this point.”

Hill, who’s also a former president of the American Medical Association, advises that looking at a team approach for primary care in rural areas would help.

“We need a new model of care,” he said. “The team approach would include a primary care physician, nurses, a nurse practitioner, pharmacist and social worker with the physician as the captain of the team. As a team, they could address a whole range of issues and care.”

At North Mississippi Medical Center, Hill is trying to integrate this team approach into the family residency program that he leads. He moved there 13 years ago to start the program, which has graduated approximately 40 family practitioners to date.

Outgoing MSMA president Dr. Dwalia South of Ripley sees health insurance as a major issue.

“Meeting the massive challenge of an overhaul of health insurance reform in a sane fashion when so many of our physicians (particularly those in primary care) are so overwhelmed and ground down by battle fatigue that they have become despondent and inert is huge,” she said. “Everyone knows there are too many people out there making mega-bucks off the current healthcare paradigm. The biggest challenge will be keeping patients paramount in all this.”

South, a family practitioner, says the most immediate but pernicious battle we face nationally is convincing congress that Medicare payment reform is a must.

“We need an educated and passionate militia of patients on our side when we go to fight for Medicare reforms in Washington,” she added. “Medicare doesn’t need just another tune-up, a patch job or any more Bondo. It needs a whole new engine.”

She laments that Mississippi ranks high in “worst firsts and lousy lasts” in health measures with the most deaths from cardiovascular disease, the most smokers per capita, the highest percentage of obesity, the highest rate of children living in poverty and, for the first time ever, the majority of babies being born to single parent households.

South would like to see the medical school class size enlarged immediately and these graduates urged to go into primary care and preventive medicine.

“Also, we need more homegrown general surgeons, general internists, pediatricians, obstetricians and family doctors caring for small town and rural Mississippi,” she said. “Aren’t we tired of being rated as a third-world country in every national poll? I know I am.”

As she passes MSMA’s leadership reins to the new president, Dr. J. Patrick Barrett, a Jackson spine surgeon, South states that Mississippi’s political powers and businesses must start improving healthcare by getting their priorities straight.

“I say the top three priorities are first, the children, second, the children and third, the children,” she said. “Without healthy children, there will be no Mississippi.”

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